#4140 of 11K

81205

HCPCS Procedure Code

HCPCS code 81205 is the #4,140 most-billed Medicaid procedure code, with $808K in payments across 47K claims from 2018–2024. The national median cost per claim is $14.59. Costs vary widely — the 90th percentile is $45.37 per claim, 3.1× the median.

Total Paid

$808K

0.00% of all spending

Total Claims

47K

Providers

Avg Cost/Claim

$17

National Cost Distribution

How much do providers bill per claim for 81205? Based on 15 providers billing this code nationally.

Median

$14.59

Average

$22.42

Std Dev

$16.60

Max

$61.93

Percentile Distribution (Cost per Claim)

p10

$10.12

p25

$12.10

Median

$14.59

p75

$28.43

p90

$45.37

p95

$51.90

p99

$59.93

50% of providers bill between $12.10 and $28.43 per claim for this code.

90% bill between $10.12 and $45.37.

Top 1% bill above $59.93.

About This Procedure

HCPCS code 81205 was billed by 20 providers across 47K claims, totaling $808K in Medicaid payments from 2018–2024. This code was used for 44K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$14.59

Providers Billing

National Spending

$808K

Avg/Median Ratio

1.54×

Moderately skewed

Top Providers Billing This Code

Ranked by total Medicaid payments for 81205

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	1114222817	$429K	$17.67	1.2× median	Above Median
2	1518415991	$115K	$13.26	0.9× median	Below Median
3	1790023547	$85K	$31.47	2.2× median	Above 75th
4	Natera Inc. San Carlos, CA · Clinical Medical Laboratory	$41K	$11.07	0.8× median	Below Median
5	Bioreference Health Llc Elmwood Park, NJ · Clinical Medical Laboratory	$30K	$22.28	1.5× median	Above Median
6	Myriad Women's Health, Inc. South San Francisco, CA · Clinical Medical Laboratory	$30K	$14.59	1.0× median	Below Median
7	1326484569	$20K	$10.95	0.8× median	Below Median
8	Quest Diagnostics Clinical Laboratories Inc Miramar, FL · Clinical Medical Laboratory	$17K	$42.03	2.9× median	Above 75th
9	1689975021	$12K	$47.60	3.3× median	Top 10%
10	1457977209	$11K	$61.93	4.2× median	Top 1%
11	1235234402	$10K	$13.13	0.9× median	Below Median
12	Invitae Corporation San Francisco, CA · Clinical Medical Laboratory	$6K	$13.68	0.9× median	Below Median
13	Quest Diagnostics Clinical Laboratories Inc Irving, TX · Clinical Medical Laboratory	$1K	$9.57	0.7× median	Below Median
14	Northwell Health Laboratories New Hyde Park, NY · Clinical Medical Laboratory	$1K	$25.39	1.7× median	Above Median
15	1568860062	$66	$1.69	0.1× median	Below Median
16	1811080526	$0	$0.00	0.0× median	Below Median
17	1043271539	$0	$0.00	0.0× median	Below Median
18	Ohioguidestone Berea, OH · Community/Behavioral Health	$0	$0.00	0.0× median	Below Median
19	1063619922	$0	$0.00	0.0× median	Below Median
20	1609449941	$0	$0.00	0.0× median	Below Median

Showing top 20 of 20 providers billing this code

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